https://doi.org/10.4081/aiua.2022.1.107
Perspectives on the urological care in Parkinson’s disease patients
Submitted: December 4, 2021
Accepted: January 6, 2022
Published: March 30, 2022
Accepted: January 6, 2022
Abstract Views: 1888
PDF: 1391
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Parkinson's disease (PD) is recognized as the most common neurodegenerative disorder after Alzheimer's disease. Lower urinary tract symptoms are common in patients with PD, either storage symptoms (overactive bladder symptoms or OAB) or voiding symptoms. The most important diagnostic clues for urinary disturbances are provided by the patient's medical history. Urodynamic evaluation allows the determination of the underlying bladder disorder and may help in the treatment selection. Pharmacologic interventions especially anticholinergic medications are the first-line option for treating OAB in patients with PD. However, it is important to balance the therapeutic benefits of these drugs with their potential adverse effects. Intra-detrusor Botulinum toxin injections, electrical stimulation were also used to treat OAB in those patients with variable efficacy. Mirabegron is a β3-agonist that can also be used for OAB with superior tolerability to anticholinergics. Desmopressin is effective for the management of nocturnal polyuria which has been reported to be common in PD. Deep brain stimulation (DBS) surgery is effective in improving urinary functions in PD patients. Sexual dysfunction is also common in PD. Phosphodiesterase type 5 inhibitors are first-line therapies for PD-associated erectile dysfunction (ED). Treatment with apomorphine sublingually is another therapeutic option for PD patients with ED. Pathologic hypersexuality has occasionally been reported in patients with PD, linked to dopaminergic agonists. The first step of treatment of hypersexuality consists of reducing the dose of dopaminergic medication. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic test, and management of PD. Lastly, the urologic outcomes and therapies are reviewed.
Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol. 2020; 27:27-42.
Lew M. Overview of Parkinson's disease. Pharmacotherapy. 2007;27:155S-160S.
DOI: https://doi.org/10.1592/phco.27.12part2.155S
Béné R, Antic S, Budisic M, et al. Parkinson's disease. Acta ClinCroat. 2009; 48:377-80.
Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol.2020; 27:27-42.
DOI: https://doi.org/10.1111/ene.14108
Sveinbjornsdottir S. The clinical symptoms of Parkinson's disease. J Neurochem. 2016; 139 (Suppl 1):318-324.
DOI: https://doi.org/10.1111/jnc.13691
Armstrong MJ, Okun MS. Diagnosis and treatment of Parkinson disease: A review. JAMA. 2020; 323:548-560.
DOI: https://doi.org/10.1001/jama.2019.22360
Baumann CR. Epidemiology, diagnosis and differential diagnosis in Parkinson's disease tremor. Parkinsonism Relat Disord. 2012; 18(Suppl 1): S90-2.
DOI: https://doi.org/10.1016/S1353-8020(11)70029-3
Schrag A, Jahanshahi M, Quinn N. How does Parkinson's disease affect quality of life? A comparison with quality of life in the general population. Mov Disord. 2000; 15:1112-8.
DOI: https://doi.org/10.1002/1531-8257(200011)15:6<1112::AID-MDS1008>3.0.CO;2-A
DeMaagd G, Philip A. Parkinson's disease and its management: Part 1: disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. P T. 2015; 40:504-32.
Pirtošek Z, Bajenaru O, Kovács N, et al. Update on the management of Parkinson's disease for general neurologists. Parkinsons Dis. 2020 ; 2020:9131474.
DOI: https://doi.org/10.1155/2020/9131474
Marsili L, Bologna M, Miyasaki JM, Colosimo C. Parkinson's disease advanced therapies . A systematic review: More unanswered questions than guidance. Parkinsonism Relat Disord. 2021; 83:132-139.
DOI: https://doi.org/10.1016/j.parkreldis.2020.10.042
Witt K, Kalbe E, Erasmi R, Ebersbach G. Nichtmedikamentöse Therapieverfahren beim Morbus Parkinson [Nonpharmacological treatment procedures for Parkinson's disease]. Nervenarzt. 2017; 88:383-390. [Article in German].
DOI: https://doi.org/10.1007/s00115-017-0298-y
Jost WH. Urological problems in Parkinson's disease: clinical aspects. J Neural Transm (Vienna). 2013; 20:587-91.
DOI: https://doi.org/10.1007/s00702-012-0914-8
Campos-Sousa RN, Quagliato E, da Silva BB, et al. Urinary symptoms in Parkinson's disease: prevalence and associated factors. Arq Neuropsiquiatr. 2003; 61:359-63.
DOI: https://doi.org/10.1590/S0004-282X2003000300007
Singer C. Urinary dysfunction in Parkinson's disease. Clin Neurosci. 1998; 5:78-86..
Batla A, Tayim N, Pakzad M, Panicker JN. Treatment options for urogenital dysfunction in Parkinson's disease. Curr Treat Options Neurol. 2016; 18:45.
DOI: https://doi.org/10.1007/s11940-016-0427-0
Seif C, Herzog J, van der Horst C, et al. Effect of subthalamic deep brain stimulation on the function of the urinary bladder. Ann Neurol. 2004; 55:118-20.
DOI: https://doi.org/10.1002/ana.10806
Kabay S, Canbaz Kabay S, Cetiner M, et al. The clinical and urodynamic results of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's Disease. Urology. 2016; 87:76-81.
Celikel E, Ozel-Kizil ET, Akbostanci MC, Cevik A. Assessment of sexual dysfunction in patients with Parkinson's disease: a case-control study. Eur J Neurol. 2008; 15:1168-1172.
DOI: https://doi.org/10.1111/j.1468-1331.2008.02278.x
Meco G, Rubino A, Caravona N, Valente M. Sexual dysfunction in Parkinson's disease. Parkinsonism Relat Disord. 2008; 14:451-6.
DOI: https://doi.org/10.1016/j.parkreldis.2007.10.008
Bronner G, Vodušek DB. Management of sexual dysfunction in Parkinson's disease. Ther Adv Neurol Disord. 2011; 4:375-83.
DOI: https://doi.org/10.1177/1756285611411504
Tysnes OB, Storstein A. Epidemiology of Parkinson's disease. J Neural Transm 2017; 124:901-905.
DOI: https://doi.org/10.1007/s00702-017-1686-y
Lee A, Gilbert RM. Epidemiology of Parkinson disease. Neurol Clin. 2016; 34:955-965.
DOI: https://doi.org/10.1016/j.ncl.2016.06.012
Abbas MM, Xu Z, Tan LCS. Epidemiology of Parkinson's disease-East versus West. Mov Disord Clin Pract. 2017; 5:14-28.
DOI: https://doi.org/10.1002/mdc3.12568
Priyadarshi A, Khuder SA, Schaub EA, Priyadarshi SS. Environmental risk factors and Parkinson's disease: a metaanalysis. Environ Res. 2001; 86:122-7.
DOI: https://doi.org/10.1006/enrs.2001.4264
Liu CC, Li CY, Lee PC, Sun Y. Variations in incidence and prevalence of Parkinson's disease in Taiwan: a population-based nationwide study. Parkinsons Dis. 2016; 2016:8756359.
DOI: https://doi.org/10.1155/2016/8756359
Del Tredici K, Braak H. Spinal cord lesions in sporadic Parkinson's disease. Acta Neuropathol. 2012; 124:643-64.
DOI: https://doi.org/10.1007/s00401-012-1028-y
Linazasoro G. Pathogenesis of PD: missing the point. Mov Disord. 2010; 25:122-3.
DOI: https://doi.org/10.1002/mds.22327
Hubble JP, Cao T, Hassanein RE, et al. Risk factors for Parkinson's disease. Neurology. 1993; 43:1693-7.
DOI: https://doi.org/10.1212/WNL.43.9.1693
Emamzadeh FN, Surguchov A. Parkinson's disease: biomarkers, treatment, and risk factors. Front Neurosci. 2018; 12:612.
DOI: https://doi.org/10.3389/fnins.2018.00612
Savica R, Grossardt BR, Carlin JM, et al. Anemia or low hemoglobin levels preceding Parkinson disease: a case-control study. Neurology. 2009; 73:1381-7.
DOI: https://doi.org/10.1212/WNL.0b013e3181bd80c1
Ball N, Teo WP, Chandra S, Chapman J. Parkinson's disease and the environment. Front Neurol. 2019; 10:218.
DOI: https://doi.org/10.3389/fneur.2019.00218
Vlajinac H, Dzoljic E, Maksimovic J, et al. Infections as a risk factor for Parkinson's disease: a case-control study. Int J Neurosci. 2013; 123:329-32.
DOI: https://doi.org/10.3109/00207454.2012.760560
Polymeropoulos MH, Lavedan C, Leroy E, et al. Mutation in the alpha-synuclein gene identified in families with Parkinson's disease. Science. 1997; 276:2045-7.
DOI: https://doi.org/10.1126/science.276.5321.2045
Bekris LM, Mata IF, Zabetian CP. The genetics of Parkinson disease. J Geriatr Psychiatry Neurol. 2010; 23:228-42.
DOI: https://doi.org/10.1177/0891988710383572
Váradi C. Clinical features of Parkinson's disease: the evolution of critical symptoms. Biology 2020; 9:103.
DOI: https://doi.org/10.3390/biology9050103
Wolters ECh. Non-motor extranigral signs and symptoms in Parkinson's disease. Parkinsonism Relat Disord. 2009 ; 15 (Suppl3):S6-12.
DOI: https://doi.org/10.1016/S1353-8020(09)70770-9
Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord. 2015; 30:1591-601.
DOI: https://doi.org/10.1002/mds.26424
Suchowersky O, Reich S, Perlmutter J, et al. Quality Standards Subcommittee of the American Academy of Neurology. Practice Parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006; 66:968-75.
DOI: https://doi.org/10.1212/01.wnl.0000215437.80053.d0
Pagano G, Niccolini F, Politis M. Imaging in Parkinson's disease. Clin Med. 2016; 16:371-5.
DOI: https://doi.org/10.7861/clinmedicine.16-4-371
Caproni S, Colosimo C. Diagnosis and differential diagnosis of Parkinson disease. Clin Geriatr Med. 2020; 36:13-24.
DOI: https://doi.org/10.1016/j.cger.2019.09.014
Jagadeesan AJ, Murugesan R, Vimala Devi S, et al. Current trends in etiology, prognosis and therapeutic aspects of Parkinson's disease: a review. Acta Biomed. 2017; 88:249-262.
Hayes MW, Fung VS, Kimber TE, O'Sullivan JD. Updates and advances in the treatment of Parkinson disease. Med J Aust. 2019;211:277-283.
DOI: https://doi.org/10.5694/mja2.50224
Stoker TB, Barker RA. Recent developments in the treatment of Parkinson's Disease. F1000 Res. 2020; 9:F1000 Faculty Rev-862.
DOI: https://doi.org/10.12688/f1000research.25634.1
Winge K, Nielsen KK. Bladder dysfunction in advanced Parkinson's disease. Neurourol Urodyn. 2012; 31:1279-83.
DOI: https://doi.org/10.1002/nau.22237
Sammour ZM, Gomes CM, Barbosa ER, et al. Voiding dysfunction in patients with Parkinson's disease: impact of neurological impairment and clinical parameters. Neurourol Urodyn. 2009; 28:510-5.
DOI: https://doi.org/10.1002/nau.20681
Winge K, Fowler CJ. Bladder dysfunction in Parkinsonism: mechanisms, prevalence, symptoms, and management. Mov Disord. 2006;21:737-45.
DOI: https://doi.org/10.1002/mds.20867
Uchiyama T, Sakakibara R, Yamamoto T, et al. Urinary dysfunction in early and untreated Parkinson's disease. J Neurol Neurosurg Psychiatry. 2011; 82:1382-6.
DOI: https://doi.org/10.1136/jnnp.2011.241075
Xing T, Ma J, Ou T. Evaluation of neurogenic bladder outlet obstruction mimicking sphincter bradykinesia in male patients with Parkinson's disease. BMC Neurol. 2021; 21:125.
DOI: https://doi.org/10.1186/s12883-021-02153-4
Yeo L, Singh R, Gundeti M, et al. Urinary tract dysfunction in Parkinson's disease: a review. Int Urol Nephrol. 2012; 44:415-24.
DOI: https://doi.org/10.1007/s11255-011-9969-y
Liu Z, Uchiyama T, Sakakibara R, Yamamoto T. Underactive and overactive bladders are related to motor function and quality of life in Parkinson's disease. Int Urol Nephrol. 2015 ; 47:751-7.
DOI: https://doi.org/10.1007/s11255-015-0951-y
Terayama K, Sakakibara R, Ogawa A, et al. Weak detrusor contractility correlates with motor disorders in Parkinson's disease. Mov Disord. 2012; 27:1775-80.
DOI: https://doi.org/10.1002/mds.25225
Araki I, Kuno S. Assessment of voiding dysfunction in Parkinson's disease by the international prostate symptom score. J Neurol Neurosurg Psychiatry. 2000; 68:429-33.
DOI: https://doi.org/10.1136/jnnp.68.4.429
Benli E, Ozer FF, Helvacı Yılmaz N, et al. Effect of bladder dysfunction on development of depression and anxiety in Parkinson's disease. Arch Ital Urol Androl. 2021; 93:336-340.
DOI: https://doi.org/10.4081/aiua.2021.3.336
Forjaz MJ, Ayala A, Rodriguez-Blazquez C, et al. Assessing autonomic symptoms of Parkinson's disease with the SCOPA-AUT: a new perspective from Rasch analysis. Eur J Neurol. 2010; 17:273-9.
DOI: https://doi.org/10.1111/j.1468-1331.2009.02835.x
Pavy-Le Traon A, Cotterill N, et al. Clinical rating scales for urinary symptoms in Parkinson disease: critique and recommendations. Mov Disord Clin Pract. 2018; 5:479-491.
DOI: https://doi.org/10.1002/mdc3.12636
Xue P, Wang T, Zong H, Zhang Y. Urodynamic analysis and treatment of male Parkinson's disease patients with voiding dysfunction. Chin Med J 2014; 127:878-81.
Shin JH, Park KW, Heo KO, et al. Urodynamic study for distinguishing multiple system atrophy from Parkinson disease. Neurology. 2019; 93:e946-e953.
DOI: https://doi.org/10.1212/WNL.0000000000008053
Vurture G, Peyronnet B, Palma JA, et al. Urodynamic mechanisms underlying overactive bladder symptoms in patients with Parkinson disease. Int Neurourol J. 2019; 23:211-218.
DOI: https://doi.org/10.5213/inj.1938086.043
Batla A, Phé V, De Min L, Panicker JN. Nocturia in Parkinson's disease: why does it occur and how to manage? Mov Disord Clin Pract. 2016; 3:443-451.
DOI: https://doi.org/10.1002/mdc3.12374
Smith M, Seth J, Batla A, et al. Nocturia in patients with Parkinson's disease. Mov Disord Clin Pract. 2015;3:168-172.
DOI: https://doi.org/10.1002/mdc3.12279
Vaughan CP, Burgio KL, Goode PS, et al. Behavioral therapy for urinary symptoms in Parkinson's disease: A randomized clinical trial. Neurourol Urodyn. 2019; 38:1737-1744.
DOI: https://doi.org/10.1002/nau.24052
McDonald C, Rees J, Winge K, et al. Bladder training for urinary tract symptoms in Parkinson disease: A randomized controlled trial. Neurology. 2020; 94:e1427-e1433.
DOI: https://doi.org/10.1212/WNL.0000000000008931
Zhang LM, Zhang XP. Investigation of Urination Disorder in Parkinson's disease. Chin Med J. 2015; 128:2906-12.
DOI: https://doi.org/10.4103/0366-6999.168049
Brusa L, Petta F, Pisani A, et al. Acute vs chronic effects of l-dopa on bladder function in patients mild Parkinson disease. Neurology. 2007; 68:1455-9.
DOI: https://doi.org/10.1212/01.wnl.0000260605.12506.86
Brusa L, Ponzo V, Stefani A, et al. Extended release levodopa at bedtime as a treatment for nocturiain Parkinson's disease: An open label study. J Neurol Sci. 2020; 410:116625.
DOI: https://doi.org/10.1016/j.jns.2019.116625
Winge K, Werdelin LM, Nielsen KK, Stimpel H. Effects of dopaminergic treatment on bladder function in Parkinson's disease. Neurourol Urodyn. 2004; 23:689-96.
DOI: https://doi.org/10.1002/nau.20054
Pagoria D, O'Connor RC, Guralnick ML. Antimuscarinic drugs: review of the cognitive impact when used to treat overactive bladder in elderly patients. Curr Urol Rep. 2011; 12:351-7.
DOI: https://doi.org/10.1007/s11934-011-0198-9
Zesiewicz TA, Evatt M, Vaughan CP, et al. Randomized, controlled pilot trial of solifenacin succinate for overactive bladder in Parkinson's disease. Parkinsonism Relat Disord. 2015; 21:514-20.
DOI: https://doi.org/10.1016/j.parkreldis.2015.02.025
Yonguc T, Sefik E, Inci I, et al. Randomized, controlled trial of fesoterodine fumarate for overactive bladder in Parkinson's disease. World J Urol. 2020; 38:2013-2019.
DOI: https://doi.org/10.1007/s00345-019-02981-7
Peyronnet B, Vurture G, Palma JA, et al. Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort. Parkinsonism Relat Disord. 2018; 57:22-26.
DOI: https://doi.org/10.1016/j.parkreldis.2018.07.005
Gubbiotti M, Conte A, Di Stasi SM, et al. Feasibility of mirabegron in the treatment of overactive bladder in patients affected by Parkinson's disease: A pilot study. Ther Adv Neurol Disord. 2019; 12:1756286419843458.
DOI: https://doi.org/10.1177/1756286419843458
Cho SY, Jeong SJ, Lee S, et al. Mirabegron for treatment of overactive bladder symptoms in patients with Parkinson's disease: A double-blind, randomized placebo-controlled trial (Parkinson's Disease Overactive bladder Mirabegron, PaDoMi Study). Neurourol Urodyn. 2021; 40:286-294.
DOI: https://doi.org/10.1002/nau.24552
Kulaksizoglu H, Parman Y. Use of botulinim toxin-A for the treatment of overactive bladder symptoms in patients with Parkinsons's disease. Parkinsonism Relat Disord. 2010; 16:531-4.
DOI: https://doi.org/10.1016/j.parkreldis.2010.06.006
Vurture G, Peyronnet B, Feigin A, et al. Outcomes of intradetrusor onabotulinum toxin A injection in patients with Parkinson's disease. Neurourol Urodyn. 2018; 37:2669-2677.
DOI: https://doi.org/10.1002/nau.23717
-Wang CC, Lee CL, Kuo HC. Efficacy and Safety of Intravesical OnabotulinumtoxinA Injection in Patients with Detrusor Hyperactivity and Impaired Contractility. Toxins. 2016; 8:82.
DOI: https://doi.org/10.3390/toxins8030082
Sakakibara R, Panicker J, Finazzi-Agro E, et al. Parkinson's Disease Subcomittee, The Neurourology Promotion Committee in The International Continence Society. A guideline for the management of bladder dysfunction in Parkinson's disease and other gait disorders. Neurourol Urodyn. 2016; 35:551-63.
DOI: https://doi.org/10.1002/nau.22764
Greenberg DR, Sohlberg EM, Zhang CA, et al. Sacral nerve stimulation in Parkinson's disease patients with overactive bladder symptoms. Urology. 2020; 144:99-105.
DOI: https://doi.org/10.1016/j.urology.2020.06.063
Kabay S, Canbaz Kabay S, Cetiner M, et al. The clinical and urodynamic results of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's Disease. Urology. 2016; 87:76-81.
DOI: https://doi.org/10.1016/j.urology.2015.09.026
Araujo TG, Schmidt AP, Sanches PRS, et al. Transcutaneous tibial nerve home stimulation for overactive bladder in women with Parkinson's disease: A randomized clinical trial. Neurourol Urodyn. 2021; 40:538-548.
DOI: https://doi.org/10.1002/nau.24595
Witte LP, Odekerken VJJ, Boel JA, et al. NSTAPS study group. Does deep brain stimulation improve lower urinary tract symptoms in Parkinson's disease? Neurourol Urodyn. 2018; 37:354-359.
DOI: https://doi.org/10.1002/nau.23301
Tabakin AL, Tunuguntla HSGR. Does deep brain stimulation improve Parkinson's disease-related lower urinary tract symptoms and voiding dysfunction? Bladder. 2021; 8:e46.
Roth B, Studer UE, Fowler CJ, Kessler TM. Benign prostatic obstruction and parkinson's disease--should transurethral resection of the prostate be avoided? J Urol. 2009; 181:2209-13.
DOI: https://doi.org/10.1016/j.juro.2009.01.049
Tyson MD, Hurd KJ, Nunez RN, et al. Temporary prostatic urethral stenting as a provocative tool to determine surgical eligibility in complex bladder outlet obstructed patients: our initial experience. Curr Urol. 2012; 6:82-6.
DOI: https://doi.org/10.1159/000343515
Gomes CM, Sammour ZM, Bessa Junior Jd, et al. Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease. Clinics 2014; 69:817-22.
DOI: https://doi.org/10.6061/clinics/2014(12)05
Sasane R, Bartels A, Field M, et al. Parkinson disease among patients treated for benign prostatic hyperplasia with 1 adrenergic receptor antagonists. J Clin Invest. 2021; 131:e145112.
DOI: https://doi.org/10.1172/JCI145112
Savard E, Declemy A, Coindreau V, et al. Auto-sondages intermittents et rétentions urinaires des syndromes parkinsoniens [Selfintermittent- catheterization and urinary retentions in Parkinsonian syndromes]. Prog Urol. 2018; 28:987-992. [Article in French].
DOI: https://doi.org/10.1016/j.purol.2017.11.004
Siegl E, Lassen B, Saxer S. Inkontinenz--ein häufiges Problem für Menschen mit einer Parkinsonerkrankung. Eine systematische Literaturübersicht [Incontinence--a common issue for people with Parkinson's disease. A systematic literature review]. Pflege Z. 2013; 66:540-4. [Article in German].
Maurer V, Stahlberg J, Schiffmann I, et al. Continence and complication rates of artificial urinary sphincter devices (AMS 800) for Parkinson and stroke patients with incontinence after prostate surgery: retrospective analysis of a prospective database. Urol Int. 2021;105:225-231.
DOI: https://doi.org/10.1159/000512051
Margolesky J, Betté S, Singer C. Management of urologic and sexual dysfunction in Parkinson disease. Clin Geriatr Med. 2020;36:69-80.
DOI: https://doi.org/10.1016/j.cger.2019.09.011
Moussa M, Papatsoris AG, Abou Chakra M, et al. Erectile dysfunction in common neurological conditions: A narrative review. Arch Ital Urol Androl. 2020; 92:371-385
DOI: https://doi.org/10.4081/aiua.2020.4.371
Pohanka M, Kanovský P, Bares M, et al. Pergolide mesylate can improve sexual dysfunction in patients with Parkinson's disease: the results of an open, prospective, 6-month follow-up. Eur J Neurol. 2004; 11:483-8.
DOI: https://doi.org/10.1111/j.1468-1331.2004.00820.x
How to Cite
Moussa, M., Abou Chakra, M., Papatsoris, A. G., Dellis, A., Dabboucy, B., Peyromaure, M. ., Barry Delongchamps, N. ., Bailly, H., & Duquesne, I. (2022). Perspectives on the urological care in Parkinson’s disease patients. Archivio Italiano Di Urologia E Andrologia, 94(1), 107–117. https://doi.org/10.4081/aiua.2022.1.107
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.